The number of drug-related deaths in Scotland soared to 1,187 last year, according to official statistics.
The figure is 27% higher than the previous year, and the highest since records began in 1996.
It means there were more drug-related deaths in Scotland last year than the 1,136 alcohol-specific deaths.
And the country's drug death rate is now nearly three times that of the UK as a whole, and is higher than that reported for any other EU country.
The latest figures also mean Scotland has a higher drug death rate than the one reported for the US, which was previously thought to be the highest rate in the world.
There were more than 70,000 drug deaths in the US in 2017 but the rate of 217 per million of the population is now marginally lower than Scotland's rate (218).
There were 3,756 deaths relating to drug poisoning in England and Wales in 2017, a rate of 66 deaths per million. The rate in Northern Ireland is about 75 per million, with 136 deaths in 2017.
However, countries differ in how deaths are recorded, and there may be under-reporting in some cases.
What do the Scottish figures show?
The statistics published by National Records of Scotland show that nearly three quarters - 72% - of those who died last year were male.
The vast majority of drug-related deaths - 1,021 - involved heroin, but a large percentage - 792 - had also taken pills such as diazepam and etizolam.
The 35-44 age group was associated with the most deaths at 442, followed by those aged 45-54 (345).
The Greater Glasgow and Clyde health board area had the highest number of deaths at 394, followed by Lothian (152), Lanarkshire (130) and Tayside (109).
But the report said that the problem was "clearly very widespread" across the whole country.
Why does Scotland have so many drug deaths?
There are said to be about 60,000 problem drug users in Scotland, which has a population of 5.4 million people.
Dr Saket Priyadarshi, of NHS Greater Glasgow and Clyde addiction services, told MPs last week that Scotland had a much higher drug death rate than the rest of the UK because it had far more problem users.
He also said that Scottish users were taking a lethal cocktail of drugs that often combined opiates such as heroin and methadone with benzodiazepines, pills often known as street valium or street blues.
Dr Priyadarshi said there was an ageing population of drug addicts, mainly men, who had been using heroin for decades and were now also taking new street pills, often containing etizolam which is stronger than prescription benzos.
It said Germany, Spain, Switzerland, Canada and, most notably, Portugal were among 25 nations to loosen the punitive attitude to drug possession to enable treatment programmes to succeed.
'I lost my mum, dad, two sisters and brother to drugs'
Jacquie, from Glenrothes in Fife, has told how her father, mother, two sisters and brother all died because of drugs.
She said losing her parents and siblings "was like a fire ripping through my family".
Jacquie, 34, is herself a recovering drug addict.
She told BBC Scotland's The Nine: "It is scary how quick it can take a grip and devastate a family.
"I feel my life has been ruined.
"People could say that has been my fault, I understand that with the drug side. I can't help the fact that I have lost all my family to the drugs. And it is hard."
Jacquie, who began taking heroin at the age of 17 and is now trying to kick the habit, said she could not remember a time when the family wasn't affected by drugs.
She is the last remaining member of her immediate family - who all lived and died in the Fife town of Glenrothes.
Scottish Public Health Minister Joe Fitzpatrick said the number of people who have lost their lives because of drug use was "shocking" and it was time for drug abuse to be treated as a public health issue.
During evidence to MPs at Westminster last week, Mr Fitzpatrick praised the "bold move" taken in Portugal to decriminalise drugs but said his government in Scotland was unable to make changes as drugs policy was reserved to Westminster.
But he has pledged to give consideration to any proposals that are brought forward by a new drugs taskforce set up by the Scottish government to examine how best to tackle the issue and save lives.
The woman leading the taskforce, Prof Catriona Matheson, told BBC Scotland the evidence for decriminalisation was strong.
She said: "It is about not putting these marginalised drug users into prison because that further marginalises them and that makes the recovery all the more difficult."
Glasgow City Council's plan for users to be able to take their own drugs under the supervision of medical staff at a special facility in the city would also need a change in UK law.
The Home Office has refused permission for Glasgow to set up the so-called "fix rooms", where users could inject heroin or cocaine in a safe and clean environment.
It was hoped the special room would encourage addicts into treatment, cut down on heroin needles on city streets and counter the spread of diseases such as HIV.
The Scottish Conservatives said the SNP has had sole control over Scotland's health and justice systems for 12 years, but has "only worsened the drugs crisis" in that time.
Tory MSP Annie Wells claimed the Scottish government was "pinning their hopes on consumption rooms, because they know it's something the UK government does not agree with".
She added: "They should be focusing their efforts on rehabilitation and abstinence-based recovery, the very services they have cut to the bone.
"Over the last decade, the Scottish government's approach has been to park vulnerable users on methadone. Yet these figures show methadone now causes even more deaths than heroin".
Meanwhile, Scottish Labour said the Scottish government has cut funding for Alcohol and Drug Partnerships by 6.3% since 2014/15.